Tri-axial seismocardiography devices and methods

ABSTRACT

A computer-implemented method may comprise providing a wireless tri-axial seismocardiography (SCG) device configured to measure and time-stamp movements of a user&#39;s chest caused by the user&#39;s heart beats; positioning the SCG device on the user&#39;s chest in a predetermined orientation and initiating a test; using the positioned SCG device, detecting, sampling, digitizing and time-stamping movement vectors of the user&#39;s chest over a predetermined period of time in each of x, y and z directions; storing the time-stamped digitized movement vectors in a memory of the SCG device and sending the time-stamped digitized movement vectors to at least one of the app on the mobile device and the remote server over a computer network; receiving, by the app on the mobile device, a plurality of fiduciary markers from the remote server, the plurality of fiduciary markers being detected from or derived using the time-stamped digitized movement vectors in each of x, y and z directions; and generating a report on the mobile device using at least some of the plurality of fiduciary markers, the report including an indication of the health of the user&#39;s heart.

BACKGROUND

Cardiac timing information has been used clinically since the 1900s andis a reliable indicator of cardiac performance and health. Myocardialrelaxation and contraction are coordinated by the intracellularrecycling of calcium ions. The timing of these cardiac events is relatedto the health of the myocardial cells. Thus, the accurate measurement ofspecific cardiac events of the cardiac cycle is clinically significant.

The electrocardiogram (ECG) is most often used in clinical settings forinitial cardiac diagnosis. The ECG provides a representation of theelectrical behavior of the heart and has been used successful to screenlarge healthy populations, such as for sport teams. However, ECG is notalways reliable to assess cardiac problems. ECG in the case of athletesmay not detect a variety of conditions such as coronary artery disease,hypertrophic cardiomyopathy and mitral valve prolapse. Echocardiography,using standard two-dimensional M-mode and Doppler ECHO, is commonly usedto evaluate cardiac performance. ECHO is considered the “gold standard”,but for routine assessment, initial screening, or group testing of sportteams, it is costly and requires technical specialists to conduct thetesting and image analysis.

Seismocardiography (hereafter, SCG) was originally described in 1877.One of the first use cases of SCG was in 1939, using a device thatmeasured the head to foot, or longitudinal motions (x-axis) of the bodycreated by cardiac contraction, and the method was then termedballistocardiography (BCG). The seismocardiogram differs in that itmeasures the transverse or sternal vibrations (z-axis) that go fromanterior to posterior of the chest. SCG, therefore, is said to measurethe reaction force caused by ejection of the blood. SCG reacts to thetransverse deflections of the chest wall and is likely a superiormodality to accurately reflect the opening and closing of the heartvalves.

The ECG is useful in generating a representation of electrical activityof the heart when there is disease or when disease is suspected. Thismakes use of this technology inherently reactive in nature. What areneeded, however, are devices, methods and technologies that enable therecording of cardiac data on a contemporaneous, immediate basis, as wellas on a long term, or daily basis. What are also needed are devices,methods and technologies that enable medically-unsophisticated users toeasily, quickly and inexpensively acquire medically-accurate andmedically-relevant data responsive to particular physiological oremotional events, such as stress or trauma. Also needed are preemptivedevices, methods and systems to monitor heart activity.

For instance, a user might want to start an exercise program or reducestress, which activity would create changes in the performance of theheart, which would be cumulative over time. Another example relates tochanges in blood pressure. Conventional ECG will not show such changesuntil the person on whom the ECG is used becomes hypertensive. The ECGcannot show timing changes in the heart immediately along with the forceof each contraction and thus cannot, in itself, be readily used to guideusers in making positive lifestyle changes. Methods, devices and systemsfor generating and storing detailed snapshots and recordings ofcumulative changes over time of heart health would address such needs.

With an increase in COVID-19 cases (more than 42.2 million as of thiswriting in October 2020), there is a great demand for research to helpalleviate some of the financial and personnel burden on the health caresystems. The most recent research related to the COVID-19 virus hasconfirmed its lethal effect on the heart, cardiovascular and respiratorysystems, with some reports stating more than 50% of the deaths arecardiac-related. Thus, it is imperative that the research communityprovide more details as to the underlying physiological changes and themechanisms causing cardiac dysfunction as a result of the COVID-19virus. This will aid practitioners to better diagnose, triage, and treatpatients in as little time as possible. Case reports of impairedsystolic function related to the coronavirus have been reported.Furthermore, other case reports have suggested that those afflicted withCOVID-19 may be at increased risk of developing myocarditis and heartfailure. Increases in high-sensitivity cardiac troponin-I can beassociated with COVID-19, and cardiac troponin-I changes can also beassociated with SARS-CoV-2, suggesting a case for acute cardiac injury.

It has been suggested that echocardiography can be used to assess anddiagnose cardiac complications related to COVID-19. Thus, an urgent needexists for devices, systems and methods to monitor cardiac health inlarge populations, populations that are not and cannot be well served byexisting ECG devices.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a first view of an SCG device according to one embodiment.

FIG. 2 is a second view of an SCG device according to one embodiment.

FIG. 3 is a third view of an SCG device according to one embodiment.

FIG. 4 shows elements of an SCG device according to one embodiment.

FIG. 5 shows other elements of an SCG device according to oneembodiment.

FIG. 6 shows an SCG device according to an embodiment, in use.

FIG. 7 is a block diagram of aspects of the hardware and software of anSCG device according to one embodiment.

FIG. 8 shows an exemplary SCG Report Card that may be generated from anSCG device, according to one embodiment.

FIG. 9 shows a graph of the cardiac data acquired over time by an SCGdevice according to one embodiment, showing the identification ofisovolumic movement.

FIG. 10 shows a graph of the cardiac data acquired over time by an SCGdevice according to one embodiment, showing the identification of theclosing of the mitral valve (MVC).

FIG. 11 shows a graph of the cardiac data acquired over time by an SCGdevice according to one embodiment, showing the identification of theaortic valve opening (AVO).

FIG. 12 shows a graph of the cardiac data acquired over time by an SCGdevice according to one embodiment, showing the identification of theend of the rapid ejection period.

FIG. 13 shows a graph of the cardiac data acquired over time by an SCGdevice according to one embodiment, showing the identification of the Lwave from three-axis SCG data.

FIG. 14 shows a graph of the cardiac data acquired over time by an SCGdevice according to one embodiment, showing the identification of theopening of the mitral valve (MVO).

FIG. 15 shows a graph of the cardiac data acquired over time by an SCGdevice according to one embodiment, showing the closure of the aorticvalve (AVC).

DETAILED DESCRIPTION

A heart at rest produces a reliable predictable seismic pattern that canbe compared with the seismic pattern generated by the heart from restthrough exercise. Embodiments provide accurate and immediate feedback toboth individuals and large populations on the health and dailyfunctioning of their heart (i.e., cardiac performance) through seismicthree-axis data that is easily acquired and stored. According toembodiments, in-depth measures may be generated of all aspects of thestatus and quality of the heart's contractions and relaxations (themechanical function of the heart), and of the manner in which the heartand the brain interact during times of stress (the heart ratevariability, HRV). Values measured and stored by devices according toembodiments compare favorably with the “Gold Standard” benchmark methodof measuring cardiac performance, Echocardiography (ECG). A light (onthe order of a few tens of grams), small, portable and handheld deviceaccording to an embodiment requires only a short period of time (e.g.,about a minute) to acquire and store data, whereas an echocardiogramstudy takes 40 to 45 minutes and requires very complex technology andthe specialized infrastructure and trained personnel of a cardiac carecenter. The cardiac data acquired and stored by a device according to anembodiment enables tracking changes in heart health by the user, throughhis or her mobile device, for example. The convenience and rapidity withwhich devices according to embodiments acquire and store heart dataenables them to track cardiac health over time, and enables users tomake informed, contemporaneous and data-driven effective lifestylechoices and decisions concerning their health and/or identify workingconditions that may be causing long-term negative changes in the heart.

One embodiment is a small device that includes a number of small sensorand a communication package and that may be pressed against the user'sbody for a short period of time, to measure a number of cardiac pointsof interest—also called fiduciary markers herein. One embodiment of thedevice comprises ultra-sensitive micro accelerometers to measure seismicwaveforms caused by the movement of the heart in the user's chest.

As noted above, when the heart is under load, it produces a simplerepeatable seismic pattern. A healthy heart under load increases theforce of contraction and, therefore, the corresponding amplitude andslope of the resulting seismic waveforms increases as well, togetherwith a reductions in the cardiac timing intervals. The present device isextremely sensitive to slight changes in the magnitude and direction ofvelocity and force vectors on the user's chest wall caused by thecontractions of the heart, and is also highly sensitive to the timeintervals needed to reach the maximum accelerations. When thesewaveforms produce lower amplitude signals, or signals of shallower slopeunder load or effort, such measures are highly specific for detectingreduced cardiac performance. These changes are progressive throughoutthe exercise for those with disease and throughout their lifetime. Thechanges in speed of acceleration cause changes in critical timingintervals that can indicate systolic (emptying) and (diastolic) changesin the pumping efficiency of the heart.

FIGS. 1, 2 and 3 shows various views of an SCG device 100 according toone embodiment. The SCG device 100 includes a sensitive triaxialaccelerometer to measure the acceleration of parts of the human bodyproduced by the heart. The SCG device 100 may (but need not) be roughlytriangular in shape, with one of the vertices thereof pointing in they-axis direction; that is, along the head-to-feet direction. Arrowsindicating the x, y and z axes may be impressed on the housing, whichmay comprise a first half 102 facing away from the user and a secondhalf 103 facing and configured to come into intimate contact with theuser's skin. An arrow indicating the x-axis may be provided, whichindicates the spatial axis aligned with left and right arms, normal tothe y-axis. Lastly, the z-axis is away from and back towards the user'schest, and is aligned generally with the central axis of the chest snapstrap 602 (shown in FIG. 6), perpendicular to both the x- and y-axes. Anon/off switch may be provided at 104, as may be a charging port 108. Aport for a removable non-volatile memory may be provided at 106.

FIGS. 4 and 5 show elements of an SCG device according to oneembodiment. As shown therein, the SCG device 100 is shown without thefirst and second halves 102, 103 of the housing, showing the containedelements. A printed circuit board, shown in simplified form at 404,supports a processor at 402, the removable memory port 106 and itscontained memory card 406, the charging port 108 and the on/off switch104. The processor 402 may include a number of communication interfacesconfigured to enable sensors to connect thereto and to facilitate datatransfer to the outside world. As shown in FIG. 5, attached to theunderside of the PCB 404 is a battery bracket 502 configured to secure acoin-sized battery 504 there against. A skin contact surface 302 is alsoprovided, and configured to conduct seismic forces from the user's chestto the tri-axial accelerometers. A tri-axial accelerometer (not shown inFIGS. 4 and 5) is also coupled to the PCB 404, as detailed below.

Using the SCG Device

Wide adoption and regular use of the present SCG device is believed tobe predicated upon usability and convenience. Toward that end, oneembodiment is the size of a large coin is configured to non-invasivelysit on the user's sternum during the test. To promote usability, thetest may be initiated by an app on the user's mobile device, whereuponthe sensors of the SCG device collect the cardiac data and wirelesslytransmit the data to the mobile device. The data may then be encryptedand, in one embodiment, sent to a secure remote server for automaticanalysis, as shown in FIGS. 9-15. Thereafter, a report as shown in FIGS.6 and 8 may be generated and stored. Once a baseline test has beenrecorded, improvements or deterioration in cardiac performance may betracked and reported each time the user undergoes a subsequent test.

Upon receiving a new SCG device according to an embodiment, the userwill download the app for his or her mobile device. Upon first openingthe app, the user will be asked to enter a User ID. The SCG device maythen be turned on, whereupon the SCG device will wirelessly connect tothe mobile device app, via a short distance communication protocol suchas Bluetooth or some other NFC protocol. The date and time may then beset, along with the local time zone. In one embodiment, the collectedheart data is stored on the SCG device's microSD card, as shown at 406in FIGS. 4 and 5. Other storage devices may be used. Afterwards, theuser's encrypted data may be uploaded to the “cloud” (e.g., the remoteserver(s) discussed herein) using the app at any time. This enables theuser to collect data even when there is no network access point, Wi-fior 5G signal available. Therefore, the present SCG device 100 may beused in conjunction with the mobile device app or by itself, storing theacquired data for later transmission, analysis and reporting. The appcan connect to the SCG device 100 any time, as long as the SCG device100 is turned on.

With reference to FIG. 6, when ready to start recording, the user maysnap the SCG device to a supplied chest strap 602 and may secure the SCGdevice 100 to his or her chest, making sure that the skin contactelement 302 (FIGS. 3, 5) sites firmly on the skin. Also, the SCG device100 should be oriented such that the bottom edge is over the top of thexiphoid process (the soft cartilage piece that ‘hangs-off’ the sternum)and such that the “UP” letters (FIGS. 1 and 2) face away from user'schest and such that the y-axis arrow in the housing points toward theuser's head. This will ensure that each of the x-, y- and z-axisaccelerometers are oriented properly and record the correct spatialdata.

To initiate the recording process, the user may start the mobile app onhis or her mobile device 604. The SCG device 100 may then be turned on,using the switch 104 at the bottom of the device. Within a few seconds,an LED light should turn on and remain solid, indicating that the SCGdevice 100 is connected to the mobile device 604 and has begun recordingseismic data. A countdown timer in the App will then start a 5 minute(for example) countdown. A flashing on the LED indicates that the 5:00minute test recording session has ended. Once the cardiac data has beensuccessfully collected, the app will so indicate.

Device Hardware

FIG. 7 is a block diagram of the physical device hardware and thesoftware of the present SCG device 100 that is configured to interactwith the hardware and enable the functionalities described and shownherein, according to an exemplary implementation. An SCG device 700,according to one embodiment, may include the elements shown in FIG. 7 orfunctional equivalents thereof, in a small, light (e.g., about 30 grams)plastic housing (best shown in FIGS. 1, 2 and 3) the size of a largecoin. A microcontroller 402 is provided, powered by a battery 718. Thebattery 718 may be a rechargeable battery, in which case, a chargingport may be provided and accommodated in the housing. In oneimplementation, the battery (reference 504 in FIG. 5) is a LIR2450 3.6volt lithium ion rechargeable coin-sized and shaped battery. Thecharging port may be a MicroUSB or USB-C port as shown at 108 coupled toa battery charger 716. Other communication and/or power transferprotocols may be used, as those of skill in this art may appreciate. Apower switch 104 may be provided, to enable the SCG device 700 to beturned on and off. The switch 728 may be manual or may beprogrammatically-actuated. A voltage regulator 730 ensures that correct,clean voltages are supplied to all constituent elements of the device700. Status and charge indicators 714, 720 may also be provided, toinform the user of the status of the device and its state of charge. Alow battery indicator 722 may also be provided, which may actuate wheninsufficient charge remains to reliably acquire cardiac SCG data. Aseparate memory 406 may be provided, to store the acquired SCG data andto provide that SCG data on demand. In one embodiment, the memory 406 isnon-volatile, such as Flash memory. In one implementation, the memory406 is a MicroSD memory card. A bootstrapping interface 726 is provided,to enable the software implementing the functionality described hereinto be loaded onto the microcontroller 402, via an integrated USBinterface over a Universal Asynchronous Receive Transmit (UART)connection, for exanpie. For example, the bootstrapping interface 726may comprise eight small conductive pads exposed on the edge of theprinted circuit board (shown in simplified form at reference 404 in FIG.4) on which the microcontroller 402 is mounted, to enable thebootstrapping device to connect thereto, via a JTAG protocol, forexample, to flash the operating program stored in the bootstrappinginterface 726 onto the microcontroller 402. An RF antenna 712 may beprovided, enabling the device 100 to communicate with a user's mobiledevice. In one implementation, the antenna 712 may be configured as aBluetooth Low Energy (BLE) antenna, enabling the establishment of ashort-range, high frequency wireless personal area network. Themicrocontroller 402 may include firmware to support both the USB and BLE(and/or others) communication protocols. Indeed, other short-rangecommunication protocols may also be implemented. A first clock crystal704 may be provided, to provide a time base for the microcontroller 402.In one implementation, the clock crystal 704 is a high frequency (e.g.,32 MHz) crystal to drive the timing of the microcontroller 402. Anotherclock crystal 742 may be provided, to drive the real-time dock 705. Theclock crystal 742 may provide oscillations at, in one implementation,32.768 kHz to the real-time clock 705, which may be configured toreliably keep the date and time for a long period of time (e.g., a fewyears), regardless whether the device 100 is on or off. The real-timeclock 705 may be used to time-stamp cardiac data with high precision andto accurate enable time-based measurements of various cardiacparameters. The real-time clock 705 may communicate with themicrocontroller 402 over, for example a two-wire interface such as theI²C. communication interface. In one implementation, the microcontroller402 is a MDBT50Q SoC microcontroller manufactured by Seeed TechnologyCo., Ltd., which is a 32-bit ARM® Cortex™ M4F CPU with 1MB FlashMemory/256 kB RAM, 48 General Purposed Input output (GPIO) pins, andsupports a number of low power wireless communication protocols, inaddition to SPI, UART, I2C, I2S, PWM, ADC, NFC, and USB interfaces.Other implementations may utilize other microcontrollers.

One embodiment comprises multi-axis accelerometers that measure theeffects on the user's chest of the motions of the heart as it movestoward and away from the chest, left to right, and head to foot.Time-stamped spatial data, as well as the first and second derivativesthereof may be acquired and/or calculated, to provide time-stampedposition, velocity and acceleration heart data. As shown in FIG. 7, themicrocontroller 402 may be coupled to a three-axis accelerometer 706. Asthe heart changes in position and as the large vessels (e.g., the aorticarch) change positions, these spatial changes induce small currentwaveforms in the accelerometers, which induced current waveforms arethen sampled, quantized and sent to the microcontroller for storage inon-board memory device (e.g., MicroSD card 708). Alternatively, thedigitized waveforms may be transmitted immediately via an app on auser's mobile device for remote analysis and reporting. The tri-axialaccelerometer 706 may be coupled to a skin contact element (reference302 in FIG. 3), configured to be pressed firmly onto the skin over thepatient's sternum, as described herein. Using such a non-invasivesensor, the SCG device 100 measures the mechanical functioning of theheart, or in other words, how the valves open and close, how the bloodflows through the heart, and how the heart twists and untwists in threedimensions as it contracts and relaxes. In so doing, the device 100 canmeasure the timing events of the heart's operation, from the closure ofthe aortic valve to the opening of the mitral valve, and the force ofcardiac contraction, or contractility, for example. Indeed, as the heartbeats, it moves left and right, up and down, and backward and forward inthe chest, and the present SCG device 100, 700 collects data thatenables a three-dimensional and time-based graphical reconstruction ofthese events to generated, by measuring the effect upon the user's chestof the movements of the cardiac muscle over all three x, y and zvectors. This allows the creation of a profile of systolic (emptying)and diastolic (filling) performance and the time required for each eventat any given heart rate. Moreover, as the data is precisiontime-stamped, the heart rate can be measured at several points in thecardiac cycle (aortic valve open, mitral valve closed and mitral valveopen).

According to one embodiment, the accelerometer 706 may be ahigh-sensitivity tri-axial accelerometer able to acquire accelerationdata along all three axes at a sufficiently high rate to enable afine-grained representation of the movement of the heart over time.Embodiments may be configured to measure accelerations of less than 1 mgand to sample all three spatial axes oftener than every 10 ms over arange greater than +/−0.5 g. In one implementation, the IMU of thetri-axial accelerometer 706 may be configured to sample all threespatial axes at 500 Hz, or once every 2 ms, at 14-bit resolution with arange of +/−2 g, meaning a resolution of 4/2¹⁴=˜0.25 mg, where g is theacceleration of gravity at sea level on Earth or about 9.8 m/sec².Coarser or finer-grained measurements may be acquired, by suitablyconfiguring the device. For example, one suitable accelerometer is thelow-power MMA8451 module manufactured by NXP Semiconductor.Advantageously, the MMA8451 includes both on-board high and low passfiltering functionality, to enable the device to filter out incidentallow or high-frequency transients, respectively, events that may not berelevant to the analysis of cardiac activity. The PCB 404 may alsoinclude Wi-Fi connectivity via a Wi-Fi controller (ESP8266 or similar inone implementation) that interfaces a smartphone application to streamthe data collected to a host on a computer network such as the Internet.

From the data collected by the accelerometer 706, one embodimentmeasures ten valuable points of interest (also referred to as fiduciarymarkers herein) in the cardiac cycle. These include atrial systole (AS),mitral valve closure (MVC), aortic valve opening (AVO), isovolumiccontraction (IC), rapid ejection period (REP), aortic valve closure(AVC), mitral valve opening (MVO), and early diastole (E wave or rapidfilling). From these points of interest, the following calculations canbe made: isovolumic contraction time (IVCT), isovolumic relaxation time(IVRT), systolic ejection period and diastolic period. These values arediagnostic for distinguishing systolic and diastolic differences and arekey to guiding interventions and early detection of cardiac performanceissues. Changes of these values over time are good indicators of changesin the efficiency of the heart. Moreover, these timing results may bedirectly and favorably compared to those obtained from echocardiography.

The above-listed Atrial systole (AS) event may be identified as thenegative peak of the Z-axis SCG data occurring after the P wave, apositive peak on the X-axis and a leftward shift on the Y-axis. Theatrial systole may be identified as a positive deflection immediatelypreceding the Q-wave.

Mitral valve close (MVC) may be identified as the first peak following Rwave of the ECG onset for the SCG marking, where the Z-axis has a largenegative deflection, X-axis is positive and Y-axis is slightly leftward.This is followed by a large recoil signal due to flow from the coronarysinus. ECHO MVC is the point on the ECHO where the close signal isdetected at the end of the rapid filling wave.

Aortic valve opening (AVO) may be identified as a leftward shift of theY-axis, a positive deflection of the Z-axis and a positive deflection ofthe X-axis. It is the first vector change from the close of the mitralvalve (MVC).

Acceleration time is identified as the first change in direction andreturn to baseline on the Z-axis and the confirming vector shift of theX-axis are defined as the end of the rapid acceleration period (REP).The REP of the SCG correlates to the peak flow signal on Doppler. Thistime period is reported in ECHO as pressure half time or accelerationtime. This signal is created by a slight repositioning movement of theventricle at the end of contraction which is detected on the SCG.

Aortic valve close (AVC) is the slope change on Z-axis that occurs nearthe end of the T-wave of the ECG. The Z-axis moves away from the chest,the X-axis moves footward and the Y-axis moves slightly rightward. InECHO Doppler mode, AVC is measured as a distinct flash at cessation offlow.

Mitral valve open (MVO) corresponds to the second negative slope on theZ-axis following the aortic close signal. The X-axis moves footward. Thesignal is negative in the Z-axis negative in the X-axis and leftward inthe Y-axis.

Early Diastolic filling wave or rapid flow corresponds to the secondrounded peak following the mitral valve open point.

Left ventricular ejection time (LVET) may be calculated from the aorticvalve open signal to the aortic valve close signal (AVO to AVC).

Diastole is defined as the period of time when the heart refills withblood after systole. The period is measured as the time from mitralvalve open to mitral valve close in the next cardiac cycle (MVO to MVC).

Isovolumic contraction time (IVCT) is the time when all heart valves areclosed and the volume in the ventricle is fixed prior to contraction andopening of the aortic and pulmonic valves it is measured from mitralvalve close to aortic valve open (MVC to AVO). Experimental studies haveshown that rapid left ventricular (LV) shape change during IVCT isessential for optimal onset of LV ejection. In terms of physicalmovement of the heart, IVCT measures the time from mitral valve close(found in the left side of the heart) to aortic valve open (which allowsblood to leave the heart). This measurement is one of the measurementsthat may indicate whether the heart is experiencing contraction(systolic) problems, which affect the blood ejection from the heart,which can be related to blood pressure issues.

Isovolumic relaxation time (IVRT) is the isovolumic period that followssystole. All valves are closed and the time is measured from aorticvalve close to mitral valve open (IVRT). This time is an indicator ofdiastolic or filling performance. Conceptually, IVRT is a short timeinterval between the end of aortic ejection (when the blood leaves theheart) and the beginning of when the ventricles begin to fill again. Ifthis time gets longer, it may be surmised that the heart is beginning toexperience additional stresses placed on the body, which stresses affecthow the heart relaxes between beats. For example, increases in IVRT maybe correlated with to blood pressure changes and/or increases in morningheart rate.

Mitral valve open to early diastolic filling wave is the time from themitral valve open to maximum inflow to the ventricle (MVO to ED), whichtiming is important for monitoring diastolic performance. The timebetween MVO and ED is the time to fill the ventricles. The ventriclespump the blood to the lungs (via the right ventricle) and to the rest ofthe body (via the left ventricle). If this time gets longer, such anincrease may indicate that the ventricles have become less receptive tothe volume of blood they are receiving. In the younger population, thismay be reversible with lifestyle changes, including exercise. In theolder population these changes can be managed with highly effectivedrugs. These timing parameters, according to embodiments, may beprovided in milliseconds and may be documented in a report madeavailable to the user.

Rapid ejection time is a measure that is associated with the systolic orcontraction performance of the heart. Taken together with both the IVRTand IVCT, the rapid ejection time provides vital information on theoverall performance of the heart, and force with which the heartcontracts. These measures may be recognized programmatically from thetri-axial time-based data recorded by the present SCG device. Supervisedlearning techniques, for example, may be leveraged to enable the readyidentification of the above-enumerated parameters. Other methods, suchas statistical analysis, may also be used.

As a result of calculating the above-identified measures, one embodimentgenerates a report for the user. Although each of the measures above maybe made available to the user, such may not be the best way ofcommunicating with lay people that are not medically trained. Oneembodiment, therefore, calculates and generates a Heart PerformanceIndex (HPI), which is a combination of the IVRT, IVCT, and the RapidEjection Time measures and which provides the user with a simple, butaccurate overall indication on the health or fitness of their heart.Both contraction and relaxation of the heart are important for hearthealth. If, over time, this number trends one way or the other,lifestyle changes (including nutrition, mental health and exercise) maybe implemented to assist the user in maintaining a healthy heart, reduceany decline in heart health or indicate the need for a moreinterventional approach.

FIG. 8 shows an example of such a report 800 that includes theaforementioned HPI. Such a report 800 may include basic information,such as the heart rate and the variability thereof. Other measures mayinclude, as shown in FIG. 8, systolic time, diastolic time, IVCT, IVRT,rapid ejection time (systole), MVO to early diastolic wave, and theejection time (diastole). An HPI 802 may then be calculated from these(and/or other) measures, to provide an at-a-glance indication of cardiachealth. In one embodiment, the report 800 may be provided on a user'smobile device or provided to a desktop computer, for example, via anemail client. Systolic time is equal to AVO to AVC. Diastolic time isequal to Mitral valve close to mitral valve open. Isovolumic contractionis equal to mitral valve close to aortic valve open. Isovolumicrelaxation is equal to aortic valve close to mitral valve open. Rapidejection time is the time from aortic valve open to maximum flow in theascending aorta. Mitral valve open to early filling wave is a measure ofventricular filling performance. In this implementation, the timingsnoted above are provided in milliseconds (ms).

Returning to FIG. 7, the acquired three-dimensional cardiac data may bestored in the memory 708 and/or transmitted over a wirelesscommunication channel to a user's mobile device 732 running a mobile app734. The received data may then be wirelessly transmitted over a network736 (including, for example, the Internet), to a remote server using aJavaScript Object Notation (JSON) Application Program interface (API)encoding scheme. JSON API exposes an implementation for data stores anddata structures, such as entity types, bundles, and fields. TheJSON-encoded data received by the remote server may then be analyzed todetect the aforementioned cardiac measures as suggested at 740 and runthrough a statistical analysis and reporting module 742 to generate,among other items, the report 800 shown in FIG. 8. Alternatively or inaddition, the acquired raw cardiac data (i.e., the time-stampeddigitized movement vectors) may be stored in the non-volatile memory 708and provided to the remote server running the web-based data managementapplication 738 directly, bypassing the user's mobile device. The raw orprocessed data may then be made available to the user's physician in aHIPAA-compliant manner and/or integrated with health-based apps such asthe Apple Health app, to identify but one possible candidate. Such datamay also be provided and formatted to be displayed by the user'ssmartwatch for an at-a-glance health cardiac checkup.

FIG. 9 shows a graph of the acquired accelerometer cardiac data overtime, such as may be used to identify and calculate and analyze cardiacparameters based upon the x, y and z data acquired by the SCG device100. Herein, the axes follow the right-hand rule, with the x-axiscorresponding to accelerometer data 904 logging movement from side toside, with movement toward the left arm being positive and toward theright arm being negative. The y-axis corresponds to accelerometer data906 logging movement from aligned with the axis from the head to thefeet, with heart movement toward the head being positive and movement ofthe heart towards the feet being negative left being negative. Lastly,the z-axis corresponds to accelerometer data 908 logging movement of theheart toward and away from the chest, with movement away from the chestbeing positive and back toward the chest being negative As showntherein, the basic ECG sinus rhythm, showing the characteristic QRSwaveform, is shown at reference 902. From this, the heart rate may bemonitored for the duration of the test. Below the ECG waveform 902, thex, y and z sensor data is shown, optionally color-coded for ease ofreference although the waveforms appear in black and white in thisdocument.

Significant to the operation of the SCG device 100 is the ability todetect, from the acquired x, y and z time-stamped accelerometer data,the opening and closing of the mitral and aortic valves. This dataenables the calculation of the isovolumic contraction times andisovolumic relaxation times, which are key parameters in making aninitial assessment of cardiac performance. The analysis of the acquireddata may begin by identifying the isovolumic movement and then goforward and backward from that identified point to get the MVC and AVOparameters. As shown in FIG. 9, the isovolumic movement 910 is thelargest negative-going waveform of z-axis trace 908. Looking at theother accelerometer data traces, trace 904 (x-axis, or side to sidedata) is moving toward the left arm but for identification, theaccelerometer trace 908 is sufficient to identify the isovolumetricmovement 910, whose amplitude is significant in detecting heart disease.

Shown in FIG. 10 is the waveform signature of the mitral valve close(MVC) event before the isovolumic movement, characterized by a roundedpeak in advance of the isovolumetric movement 910. The onset of thispeak is the MVC signal 1002.

FIG. 11 shows the x, y and z accelerometer data acquired by the SCGdevice 100, showing identification of the aortic valve open or AVO. Theisovolumic twist develops a force that is sufficient to open the AVvalves. The valves opens but this does not create much of a seismicsignal. As shown in FIG. 11, there is an upward direction change on thez-axis trace 908 and a direction change on both the x axis 904 and the yaxis 906 accelerometer data. At the point where they cross with thepositive going z-axis accelerometer data 908 is where the aortic valveopens; namely, the AVO point.

The next time the accelerometers cross is at the end of the rapidejection period. The ventricle stops acceleration and resets to arelaxed position, as shown in FIG. 12. Thereafter, the diastolic signalsare identified. The first signal of interest is the resetting of theventricle after the aortic valve closes. FIG. 13 shows the portion ofthe accelerometer trace 908 identified as the L wave. Once the L wave isidentified, the mitral valve open signal MVO may be identified as beinglocated on the upslope of the ascending signal and is identified by theother accelerometers, as shown in FIG. 14. Lastly, as the aortic valvecloses quietly, the only indication is a toward-the-back movement as theaorta recoils after closure. The detected AVC is shown in FIG. 15. Otherways of detecting the AVC are possible. Following the closure, theventricle untwists with a reverse of the isovolumic contraction wave.The next event is the early diastolic filling, whereupon the cyclerepeats. For at least some of these identified fiduciary markers,comparison with threshold values may help identify them as being normalor potentially abnormal. Moreover, comparing like measured or derivedparameters over time may help in identifying beneficial or detrimentalchanges in the functioning of the heart muscle.

The SCG heart data (i.e., the acquired and time-stamped digitizedmovement vectors) may then be uploaded, while keeping the present SCGdevice turned on. The date and time of any recordings stored on thedevice will be displayed. Once the upload is complete, a heart healthdata report may then be generated and presented to the user, showing theuser's heart rate in beats per minute (bpm), and an indication of thequality of the recording as “Good”, “OK” or “Bad”. The SCG datarecording may also be carried out independently (i.e., without)involvement of the mobile device app. A “Bad” quality indication mayresult in the device prompting the user to repeat the test, taking careto snuggly position the SCG device on his or her chest to ensurereliable readings.

The data for each individual heart, therefore, has a number of so-calledfiduciary points or markers. These may include the aforementioned atrialsystole (AS), mitral valve closure (MVC), aortic valve opening (AVO),isovolumic contraction (IC) rapid ejection period (REP), aortic valveclosure (AVC), mitral valve opening (MVO), early diastole (E wave orrapid filling) and the derived isovolumic contraction time (IVCT), andisovolumic relaxation time (IVRT). Surprisingly and unexpectedly, thecombination of these fiduciary markers appear to be unique to eachindividual and may, therefore, be used to positively identify theperson. The stored and/or contemporaneously-acquired heart data asdescribed herein, therefore, may be used, alone or in combination withother biometric indicators, to identify people in high securitysituations, site access control and the like. The cardiac data soacquired is generally invariable over reasonable periods of time anddoes not change unless there is ischemia or damage from an infarct.Surprisingly, over several thousand testing sessions, it became clearthat specific individual users, using the fiduciary markers, could bepositively identified without any name after a just a few tests. Oneembodiment, therefore, of the present SCG device 100 may be used topositively identify the user, independent of any provided personalidentifying information. Indeed, by comparing recently-acquired heartdata of one person of a plurality of persons with previously-acquiredheart data of the plurality of persons, a match (or a partial match thatmeets a predetermined similarity threshold) may be used to verify theidentity of the person with a high degree of confidence, as thefiduciary markers, taken in the aggregate, may be seen to be thecardiac-analogue to fingerprints, unique to each individual.

An echocardiogram looks for heart abnormalities in the motion of theheart wall, which is how physicians identify ischemia and cardiacinfarcts. The present SCG device acquires detailed and fine-grainedmeasures of heart wall movement using three spatial vectors, whichenables the generation of a profile of normal amplitudes and directionof change, using a single lead, a handheld device and a mobile device.For example, mitral or aortic insufficiency or stenosis is apparent inthe data collected by the present SCG device as a noticeable extrasignal representative of regurgitant flow or jetting across the aorticvalve. This and similar telltale signals are easily spotted as sharpchanges in direction during the aortic valve opening or closing timing,IVCT and IVRT.

Other applications include the force of ventricular contraction. Thismanifests itself as a twist force, which may be calculated from acombination of the time-dependent x, y and z-axis accelerometer data.The untwist mechanics of the heart may also reveal themselves as themagnitude of the L-wave as a percentage of I-wave (twist of theventricle) and this ratio may be used to determine the level of fitnessof the user. Also, changes in the MVO opening, as evidenced bysuccessive SCG testing sessions over a period of time may correlatedwith changes in stress or fatigue. Many other physiological parameters,measurements and calculations may be made once a precise, time-stampedthree-dimensional representation of the movement of the heart isacquired and stored. Machine learning techniques may be employed to goodeffect on anonymized 3-D cardiac data acquired by the present SCGdevices to identify heart function disorders and degradations, and toidentify clusters of users with particular ailments and generally todeduce heart-related information across users, in large populations. Inturn, this may lead to pre-emptive heart health care initiatives andadvance the state of the art in cardiac care and public health.

One embodiment, therefore, is a seismocardiography system comprising awireless tri-axial seismocardiography (SCG) device. According to oneembodiment, the SCG device may comprise a housing comprising a skincontact surface configured to contact skin of a user's chest wall and anouter surface disposed away from and facing away from the skin contactsurface; and a printed circuit board (PCB) disposed in the housing. ThePCB is configured to support and interconnect a processor; a three-axisaccelerometer module comprising an Inertial Measurement Unit (IMU); acommunication module configured to communicate with an app on a mobiledevice and with a remote server over a computer network; a power source;a time base;

and memory. The processor may be configured to cause the IMU of thethree-axis accelerometer module, when the device is positioned on theuser's chest in a predetermined orientation during a test, to detect,sample and digitize movement vectors of the user's chest caused by theuser's heart beats over a predetermined period of time in each of x, yand z directions, and to store the digitized movement vectors in thememory together with time-stamp information generated by the time baseand to send the time-stamped digitized movement vectors to at least oneof the app on the mobile device and the remote server using thecommunication module.

According to further embodiments, the system may comprise a chest strapconfigured to encircle the user's chest, or a single gel-electrode thatcan be secured to the chest sternum, to record the heart activity fromthe user's chest wall. In one embodiment, the remote server may beconfigured to recognize, from the time-stamped digitized movementvectors, a plurality of fiduciary markers in a cardiac cycle of theuser. The remote server may be configured to generate, from thetime-stamped digitized movement vectors, a heart performance indexconfigured to provide an indication of health and fitness of the user'sheart and to send the generated heart performance index to the mobiledevice for display to the user. The remote server may be furtherconfigured to recognize a plurality of fiduciary markers, from thetime-stamped digitized movement vectors, the fiduciary markers includingat least some of atrial systole (AS); mitral valve closure (MVC); aorticvalve opening (AVO); isovolumic contraction (IC); rapid ejection period(REP); aortic valve closure (AVC); mitral valve opening (MVO), and earlydiastole (E wave or rapid filling). The remote server may be furtherconfigured to calculate, from at least some of the fiduciary markers, atlast one of isovolumic contraction time (IVCT) isovolumic relaxationtime (IVRT) systolic ejection period and diastolic period and togenerate a Heart Performance Index therefrom, and to send the generatedHeart Performance Index to the mobile device for display to the user bythe app. The remote server may be further configured to detect, changesto at least some of IVCT, IVRT, systolic ejection period and diastolicperiod over consecutive tests and to provide therefrom indicators ofchanges over time in the efficiency of the user's heart.

According to one embodiment, the processor, the three-axis accelerometermodule, and the time base may be configured to sample and digitize themovement vectors of the user's chest in each of x, y and z directions atleast as often as every 2 ms within a range of at least +/−2 g at anacceleration resolution of 0.25 mg or smaller. Other specifications maybe implemented. The time-stamped digitized movement vectors may beconfigured to enable at least the remote server to determine a rate andmanner with which the user's heart twists and untwists across the x, yand z axes over time. The time-stamped digitized movement vectors may beconfigured to enable at least the remote server to identify mitral oraortic insufficiency or stenosis as sharp changes in direction duringisovolumic contraction time (IVCT) and isovolumic relaxation time(IVRT).

Another embodiment is a computer-implemented method, comprising awireless tri-axial seismocardiography (SCG) device configured to measureand time-stamp movements of a user's chest caused by the user's heartbeats; positioning the SCG device on the user's chest in a predeterminedorientation and initiating a test; using the positioned SCG device,detecting, sampling, digitizing and time-stamping movement vectors ofthe user's chest over a predetermined period of time in each of x, y andz directions; storing the time-stamped digitized movement vectors in amemory of the SCG device and sending the time-stamped digitized movementvectors to at least one of the app on the mobile device and the remoteserver over a computer network; receiving, by the app on the mobiledevice, a plurality of fiduciary markers from the remote server, theplurality of fiduciary markers being detected from or derived using thetime-stamped digitized movement vectors in each of x, y and zdirections; and generating a report on the mobile device using at leastsome of the plurality of fiduciary markers, the report including anindication of the health of the user's heart.

According to further embodiments, providing may be carried out with theSCG device comprising a housing comprising a skin contact surfaceconfigured to contact skin of the user's chest and an outer surfacedisposed away from and facing away from the skin contact surface, aprinted circuit board (PCB) disposed in the housing and configured tosupport and interconnect a processor, a three-axis accelerometer modulecomprising an Inertial Measurement Unit (IMU), a communication moduleconfigured to communicate with the app on the mobile device and with theremote server over a computer network, a power source, a time base andthe memory. The computer-implemented method may further comprise theremote server generating, from the sent time-stamped digitized movementvectors, a heart performance index configured to provide an indicationof health and fitness of the user's heart and sending the generatedheart performance index to the mobile device for display to the user.The method may further comprise the remote server analyzing thetime-stamped digitized movement vectors and identifying a plurality offiduciary markers therein, the fiduciary markers including at least someof atrial systole

(AS); mitral valve closure (MVC); aortic valve opening (AVO); isovolumiccontraction (IC); rapid ejection period (REP); aortic valve closure(AVC); mitral valve opening (MVO), and early diastole (E wave or rapidfilling).

In one embodiment, the remote server may be configured to calculate,from the identified fiduciary markers, at last one of isovolumiccontraction time (IVCT), isovolumic relaxation time (IVRT), systolicejection period and diastolic period to enable a generation of a heartperformance index therefrom and a display of the generated heartperformance index on the app of the mobile device. The method mayfurther comprise the remote server calculating changes to at least someof IVCT, IVRT, systolic ejection period, and diastolic period overconsecutive tests and to providing therefrom indicators of changes inthe efficiency of the user's heart for display on the app of the mobiledevice. The SCG device may be configured to sample and digitize themovement vectors of the user's chest in each of x, y and z directions,for example, at least as often as every 2 ms within a range of at least+/−2 g at an acceleration resolution of 0.25 mg or smaller. Thecomputer-implemented method may further comprise the remote serverdetermining, from the time-stamped digitized movement vectors, a rateand manner with which the user's heart twists and untwists across the x,y and z axes over time. The remote server may be configured to identify,from the time-stamped digitized movement vectors, sharp changes indirection during isovolumic contraction time (IVCT), and isovolumicrelaxation time (IVRT) as indicators of mitral or aortic insufficiencyor stenosis.

It is to be understood that the present computer-implemented method maybe configured such that the SCG device carries out some or all of thecalculations and computations disclosed above to be carried out by theremote server(s). Likewise, rather than the remote server(s) carryingout the above-disclosed calculations and computations, some or all maybe carried out by the user's mobile device or in part by the present SCGdevice, in part by the user's mobile device (and, optionally in part bya remote server). Indeed, one embodiment has the SCG device and/or theuser's mobile device carry out all of the above-detailed analyses andcomputations, thereby obviating the need to upload the encrypteddigitized movement vectors to the remote server over the network, otherthan for disaster-proofing and long-term storage, for example.

Yet another embodiment is a computer-implemented method, comprisingproviding at least one wireless tri-axial seismocardiography (SCG)device configured to measure and time-stamp movements of a user's chestcaused by the user's heart beats; using the provided at least one SCGdevice, carrying out at least one test for each of a plurality of users.Each test may comprise positioning the SCG device on the user's chest ina predetermined orientation; using the positioned SCG device, detecting,sampling, digitizing and time-stamping movement vectors of the user'schest over a predetermined period of time in each of x, y and zdirections; sending the time-stamped digitized movement vectors to aremote server over a computer network; identifying and storing, by theremote server, a set of fiduciary markers in each test using thetime-stamped digitized movement vectors in each of x, y and z directionsand associating each the sets of fiduciary markers with a predeterminedone of the plurality of users. Thereafter, the method may furthercomprise subsequently testing of one of the plurality of users andgenerating a corresponding time-stamped digitized movement vectors;generating a subsequent set of fiduciary markers using the correspondingtime-stamped digitized movement vectors in each of x, y and zdirections; comparing the corresponding fiduciary markers generatedduring the subsequent test with the stored sets of fiduciary markers toidentify at least one matching set of stored fiduciary markers; andidentifying which of the plurality of users was subsequently tested asthe predetermined user whose associated set of stored fiduciary markersat least partially matches the corresponding fiduciary markers generatedduring the subsequent test.

Further, the SCG device, the user's mobile device and the remoteserver(s) are described as carrying specific roles, computations andcalculations. However, any of these roles, computations and calculationsmay be carried out in whole or in part by the SCG device, the user'smobile device or the remote servers. Indeed, offloading heart healthindex, fiduciary marker computations to the remote server(s) and/or theuser's mobile device is a design choice and may be guided bycost-effectiveness considerations, among others. These may also becarried out internally by the present SCG device, given sufficientcomputing power and memory resources. Therefore, embodiments are not tobe limited by which of the SCG device, the user's mobile device and theremote server(s) carry out which computation and functions. These may bedistributed at will, to best leverage the available computationalresources in each of these devices.

Portions of the detailed description above describe processes andsymbolic representations of operations by computing devices that mayinclude computer components, including a local processing unit, memorystorage devices for the local processing unit, display devices, andinput devices. Furthermore, such processes and operations may utilizecomputer components in a heterogeneous distributed computing environmentincluding, for example, remote file servers, computer servers, andmemory storage devices. These distributed computing components may beaccessible to the local processing unit by a communication network.

The processes and operations performed by the computer include themanipulation of data bits by a local processing unit and/or remoteserver and the maintenance of these bits within data structures residentin one or more of the local or remote memory storage devices. These datastructures impose a physical organization upon the collection of databits stored within a memory storage device and represent electromagneticspectrum elements. Moreover, the computer-implemented methods disclosedherein improve the functioning of computers by a user to administerself-test and to obtain therefrom a detailed analysis of the health andefficiency of his or her heart, and to generate a detailed history offiduciary markers that are useful in tracking the efficiency of theheart over time. Such computer-implemented methods are not capable ofbeing effectively carried out by the mental processes of humans.

A process, such as the computer-implemented methods described and shownherein, may generally be defined as being a sequence ofcomputer-executed steps leading to a desired result. These stepsgenerally require physical manipulations of physical quantities.Usually, though not necessarily, these quantities may take the form ofelectrical, magnetic, or optical signals capable of being stored,transferred, combined, compared, or otherwise manipulated. It isconventional for those skilled in the art to refer to these signals asbits or bytes (when they have binary logic levels), pixel values, works,values, elements, symbols, characters, terms, numbers, points, records,objects, images, files, directories, subdirectories, or the like. Itshould be kept in mind, however, that these and similar terms should beassociated with appropriate physical quantities for computer operations,and that these terms are merely conventional labels applied to physicalquantities that exist within and during operation of the computer.

It should also be understood that manipulations within the computer areoften referred to in terms such as adding, comparing, moving,positioning, placing, illuminating, removing, and altering and the like.The operations described herein are machine operations performed inconjunction with various input provided by a human or artificialintelligence agent operator or user that interacts with the computer.The machines used for performing the operations described herein includelocal or remote general-purpose digital computers or other similarcomputing devices.

In addition, it should be understood that the programs, processes,methods, etc. described herein are not related or limited to anyparticular computer or apparatus nor are they related or limited to anyparticular communication network architecture. Rather, various types ofgeneral-purpose hardware machines may be used with program modulesconstructed in accordance with the teachings described herein.Similarly, it may prove advantageous to construct a specializedapparatus to perform the method steps described herein by way ofdedicated computer systems in a specific network architecture withhard-wired logic or programs stored in nonvolatile memory, such as readonly memory.

While certain example embodiments have been described, these embodimentshave been presented by way of example only, and are not intended tolimit the scope of the embodiments disclosed herein. Thus, nothing inthe foregoing description is intended to imply that any particularfeature, characteristic, step, module, or block is necessary orindispensable. Indeed, the novel methods and systems described hereinmay be embodied in a variety of other forms; furthermore, variousomissions, substitutions and changes in the form of the methods andsystems described herein may be made without departing from the spiritof the embodiments disclosed herein.

While certain embodiments of the disclosure have been described, theseembodiments have been presented by way of example only, and are notintended to limit the scope of the disclosure. Indeed, the novelmethods, devices and systems described herein may be embodied in avariety of other forms. Furthermore, various omissions, substitutionsand changes in the form of the methods and systems described herein maybe made without departing from the spirit of the disclosure. Theaccompanying claims and their equivalents are intended to cover suchforms or modifications as would fall within the scope and spirit of thedisclosure. For example, those skilled in the art will appreciate thatin various embodiments, the actual physical and logical structures maydiffer from those shown in the Figures. Depending on the embodiment,certain steps described in the example above may be removed, others maybe added. Also, the features and attributes of the specific embodimentsdisclosed above may be combined in different ways to form additionalembodiments, all of which fall within the scope of the presentdisclosure. Although the present disclosure provides certain preferredembodiments and applications, other embodiments that are apparent tothose of ordinary skill in the art, including embodiments which do notprovide all of the features and advantages set forth herein, are alsowithin the scope of this disclosure. Accordingly, the scope of thepresent disclosure is intended to be defined only by reference to theappended claims.

1. A computer-implemented method, comprising: providing a wirelesstri-axial seismocardiography (SCG) device configured to measure andtime-stamp movements of a user's chest caused by the user's heart beats;positioning the SCG device on the user's chest in a predeterminedorientation and initiating a test; using the positioned SCG device,detecting, sampling, digitizing and time-stamping movement vectors ofthe user's chest over a predetermined period of time in each of x, y andz directions; storing the time-stamped digitized movement vectors in amemory of the SCG device and sending the time-stamped digitized movementvectors to at least one of the app on the mobile device and the remoteserver over a computer network; receiving, by the app on the mobiledevice, a plurality of fiduciary markers from the remote server, theplurality of fiduciary markers being detected from or derived using thetime-stamped digitized movement vectors in each of x, y and zdirections; and generating a report on the mobile device using at leastsome of the plurality of fiduciary markers, the report including anindication of the health of the user's heart.
 2. Thecomputer-implemented method of claim 1, wherein providing is carried outwith the SCG device comprising a housing comprising a skin contactsurface configured to contact skin of the user's chest and an outersurface disposed away from and facing away from the skin contactsurface, a printed circuit board (PCB) disposed in the housing andconfigured to support and interconnect a processor, a three-axisaccelerometer module comprising an Inertial Measurement Unit (IMU), acommunication module configured to communicate with the app on themobile device and with the remote server over a computer network, apower source, a time base and the memory.
 3. The computer-implementedmethod of claim 1, further comprising the remote server generating, fromthe sent time-stamped digitized movement vectors, a heart performanceindex configured to provide an indication of health and fitness of theuser's heart and sending the generated heart performance index to themobile device for display to the user.
 4. The computer-implementedmethod of claim 1, further comprising the remote server analyzing thetime-stamped digitized movement vectors and identifying a plurality offiduciary markers therein, the fiduciary markers including at least someof: atrial systole (AS); mitral valve closure (MVC); aortic valveopening (AVO); isovolumic contraction (IC); rapid ejection period (REP);aortic valve closure (AVC); mitral valve opening (MVO), and earlydiastole (E wave or rapid filling).
 5. The computer-implemented methodof claim 4, further comprising the remote server calculating, from theidentified fiduciary markers, at last one of isovolumic contraction time(IVCT), isovolumic relaxation time (IVRT), systolic ejection period anddiastolic period to enable a generation of a heart performance indextherefrom and a display of the generated heart performance index on theapp of the mobile device.
 6. The computer-implemented method of claim 5,further comprising the remote server calculating changes to at leastsome of IVCT, IVRT, systolic ejection period and diastolic period overconsecutive tests and to providing therefrom indicators of changes inthe efficiency of the user's heart for display on the app of the mobiledevice.
 7. The computer-implemented method of claim 1, furthercomprising configuring the SCG device to sample and digitize themovement vectors of the user's chest in each of x, y and z directions atleast as often as every 2 ms within a range of at least +/−2 g at anacceleration resolution of 0.25 mg or smaller.
 8. Thecomputer-implemented method of claim 1, further comprising the remoteserver determining, from the time-stamped digitized movement vectors, arate and manner with which the user's heart twists and untwists acrossthe x, y and z axes over time.
 9. The computer-implemented method ofclaim 1, further comprising the remote server to identifying, from thetime-stamped digitized movement vectors, sharp changes in directionduring isovolumic contraction time (IVCT) and isovolumic relaxation time(IVRT) as indicators of mitral or aortic insufficiency or stenosis.